Chile
Outperforms U.S. and Dramatically Reduces Maternal Deaths by Increasing Women's
Educational Level
Concepción, Chile, May 5
- A
scientific analysis of 50 years of maternal mortality data from Chile has found
that the most important factor in reducing maternal mortality is the
educational level of women. “Educating women enhances women’s ability to access
existing health care resources, including skilled attendants for childbirth,
and directly leads to a reduction in her risk of dying during pregnancy and
childbirth,” according to Dr Elard Koch, epidemiologist and leading author of
the study.
The research entitled
“Women’s Education
Level, Maternal Health Facilities, Abortion Legislation and Maternal Deaths: a
Natural Experiment in Chile from 1957 to 2007” was conducted by researchers Dr Elard Koch, Dr John Thorp and Dr Sebastian Gatica on behalf
of the Chilean Maternal Mortality Research Initiative (CMMRI) and published in the Friday, May 4
issue of PLoS ONE. (http://dx.plos.org/10.1371/journal.pone.0036613).
Using 50 years of official
data from Chile’s National Institute of Statistics (1957-2007), the authors
looked at factors likely to affect maternal mortality, such as years of
education, per capita income, total fertility rate, birth order, clean water
supply, sanitary sewer, and childbirth delivery by skilled attendants. They
also analyze the effect of historical educational and maternal health policies,
including legislation that has prohibited abortion in Chile since 1989, on
maternal mortality.
During the fifty-year study
period, the overall Maternal Mortality Ratio or MMR (the number of maternal
deaths related to childbearing divided by the number of live births) dramatically
declined by 93.8%, from 270.7 to 18.2 deaths per 100,000 live births between
1957 and 2007, making Chile a paragon for maternal health in other countries. “In
fact, during 2008, the overall MMR declined again, to 16.5 per 100,000 live
births, positioning Chile as the country with the second lowest MMR in the
American continent after Canada and with at least two points lower MMR than United
States” said Koch.
One of the
most significant findings is that, contrary to widely-held assumptions, making
abortion illegal in Chile did not result in an increase in maternal mortality. In fact, after abortion was made illegal in 1989, the
MMR continued to decrease from 41.3 to 12.7 per 100,000 live births (69.2%
reduction). “Definitively, the legal prohibition of abortion is unrelated to
overall maternal mortality rates” emphasized Koch.
The variables affecting
this decrease included the predictable factors of delivery by skilled attendants,
complementary nutrition for pregnant women and their children in the primary
care clinics and schools, clean facilities, and fertility. But the most
important factor and the one which increased the effect of all others was the
educational level of women. For every additional year of maternal education
there was a corresponding decrease in the MMR of 29.3 per 100,000 live births.
The picture for Chile
includes a transition of leading causes of death along with an accelerated
decline of fertility and delayed motherhood. Koch explained that direct causes
–those directly attributable to pregnancy condition– were the rule before 1990,
but from then, indirect causes –i.e.
non-obstetric chronic conditions such as hypertension and diabetes among
others– rise as the most prevalent, hindering the decline on maternal
mortality.
“This study uncovers an
ongoing ‘fertility paradox’ in maternal health: education is the major
modulator that has helped Chile to reach one of the safest motherhood in the
world, but also contributes to decrease fertility, excessively delaying
motherhood and puts mothers on risk because of their older age.” Thus, an emerging
problem nowadays “is not a question of how many children a mother has, but a
question of when a mother has her children, specially the first of them” concluded
Koch.
